The use of regional anesthesia in pediatrics (pRA) has dramatically increased over the past 30 years, as it provides localized pain relief, diminishes opioid use, and facilitates earlier mobilization, enteral feeding and hospital discharge1. The technique is also used increasingly due to concerns about the effect of general anesthesia on brain development.
For several reasons, local anesthetic toxicity will become a major safety risk as pRA gains greater acceptance. First, dosing guidelines for children are mostly unknown and are based on expert conjecture3-6. Second, systemic toxic reactions present vastly differently in children than in adults, as they will not show early signs of toxicity because pRAs are mostly performed under deep sedation or general anesthesia. Finally, no tools are available to determine local anesthetic toxicity, other than observation of significant hemodynamic changes.
Improved devices and methods for delivery of pediatric anesthesia are needed.